PROJECT SUMMARY Strategies to improve the psychological health of children with cancer are greatly needed. Pediatric oncology patients are a special population because of their often long and frequent hospital stays and because of their compromised immune systems. Pilot data suggest that therapy dog visits can reduce distress in this population. However, concerns about risk of infection are barriers to implementing animal-assisted activities (AAA) programs in pediatric oncology settings. No efficacy studies, let alone rigorous randomized controlled trials, have been published on AAA for pediatric oncology inpatients. And no prospective studies have measured pathogen transmission associated with AAA in any setting. The proposed study will rigorously test whether therapy dog visits reduce distress, lower treatment-related anxiety, increase happiness, and improve satisfaction with hospital care in hospitalized children with cancer (Aim 1). This study will also contribute to knowledge about the safety of therapy dog visits by determining whether these visits increase microbial levels on patients? hands (Aim 2), which could increase infection risk. A randomized controlled trial of 40 pediatric oncology patients (aged 6-17) will be conducted at Seattle Children?s Hospital, a large, quaternary-care medical center in the Pacific Northwest that serves Washington, Alaska, Montana, and Idaho. Patients will be randomized 1:1 to usual care or to the intervention, which will consist of twice-weekly therapy dog visits. Distress and other psychological health outcomes after each visit, at discharge, and 2 weeks post discharge will be assessed using patient surveys with standardized, validated instruments. Microbial levels will be assessed by culturing patients? hands using a standard method. Rigorous methods for clinical trials (e.g., allocation concealment, intent-to-treat analyses) will be employed to ensure high quality results. This study will provide hospitals and care providers with information needed to make evidence-based decisions about offering therapy dog visits to pediatric oncology inpatients. If this study demonstrates therapy dog visits can improve the psychological health of pediatric oncology inpatients without transmitting pathogens, evidence-based programs could improve cancer-care experiences for children nationwide. If therapy dog visits improve psychological health but transmit pathogens that remain on children?s hands, further research can evaluate strategies to reduce this risk. If therapy dog visits do not reduce distress for pediatric oncology inpatients, future studies can adapt and tailor ?active ingredients? from other AAA interventions in other settings. Thus, findings from the proposed study are expected to have a large impact on clinical practice and future AAA research. The proposed study directly responds to the National Institute of Child Health and Human Development?s goal of stimulating rigorous research on animal-assisted interventions for special populations.